Edzard Ernst is the first professor of complementary and alternative medicine (CAM). He began 20 years ago as a CAM enthusiast, and a trained homeopath, and genuinely wanted to point the critical eye of science onto CAM. Many CAM proponents claim this, but Ernst was different in a key respect – he wanted to use rigorous scientific research to find out if CAM worked, not to prove that it does.

Unfortunately, we also had a few co-workers who, despite of our best efforts, proved to be unable of critical thinking, and more than once this created unrest, tension and trouble. When I analyse these cases in retrospect, I realise how quasi-religious belief must inevitably get in the way of good science. If a person is deeply convinced about the value of his/her particular alternative therapy and thus decides to become a researcher in order to prove his/her point, serious problems are unavoidable.

Problems are indeed unavoidable. There is a problem with researcher bias and publication bias in medical research. Science magazine also reports on a “sting” operation in which an author submitted a hopelessly flawed paper to 304 open access journals, with more than half accepting the paper for publication. There are plenty of places to publish terrible research that proves whatever point you wish to make.

Researchers need to have a sincere desire to find out if something is really true, not just confirm their biases. They also need to have the technical knowledge to conduct rigorous research. This includes critical thinking skills and detailed knowledge of all the ways in which science can go wrong. Ernst came to his CAM research career, apparently, with these attributes.

After 20 years and more than 1000 papers published in the peer-reviewed literature, Ernst has come to the following conclusions:

The concepts that underpin alternative treatments are often not plausible and must be assessed critically.

Most claims made for alternative medicine are unproven and quite a few should be regarded as disproven.

Very few alternative therapies demonstrably generate more good than harm.

Looking back to those 20 years, I am struck by the frequency with which I encountered intellectual dishonesty and denial of facts and evidence. Medical research, I had previously assumed is a rather dry and unemotional business – not so when it comes to research into alternative medicine! Here it is dominated by people who carry so much emotional baggage that rational analysis becomes the exception rather than the rule.

Twenty years ago CAM proponents were clamoring for research funding so that they could prove to the world that their preferred magical treatments worked. They then used (and still use) the very fact that their treatments were being researched as an argument that they are respectable and plausible.

When the evidence showed that their treatments do not work, they blamed science, they blamed the researchers (in this case, Ernst), they tried to change the rules, and they argued that placebo effects are real. In effect, they got what they asked for, scientific attention to their claims. They did not like the results, however.

They very much proved Ernst’s point – my own experience with CAM proponents is that they are starting from a firm conclusion that CAM works (or at least their preferred CAM). They have “seen it work in their practice” and cannot conceive of a universe in which their anecdotal observations do not reflect reality.

Starting with that assumption, therefore, any research that shows otherwise must be flawed. The only point of research is to prove to the world that their claims are true (since they know their claims are true). So they keep changing the rules of science until it shows them the results they want.

Unfortunately, over the last 20 years CAM proponents have successfully infiltrated the institutions of science and medicine, and they are largely now their own keepers. They have their own journals, they are often deferred to as the “experts” and so fill panels and committees on CAM, and regulate their own professions.

All of this happened while the scientific evidence increasingly was showing what any scientifically literate person could have predicted – highly implausible claims are unlikely to be true, so it’s no surprise they turned out not to be true.

CAM is CAM because it is not science-based. If it were, it would not be “alternative” medicine, it would be medicine.

Ernst has produced an impressive body of quality scientific research that overwhelmingly shows CAM to be the pseudoscience it seems to be. CAM proponents are now doing everything they can to shoot the messenger. They appear to prefer their profitable fiction to scientific reality, and despise anyone who will point out that the Emperor has no clothes.

7 Responses to “CAM Research – Be Careful What You Wish For”

While I accept most of what you say, your definitions imply that the only valid medicine is what comes through conventional medical research. Might there not be potential remedies that are not being researched and developed by those who do most of this research?

I can think of several reason why potential remedies might not be attractive for pharmaceutical companies or universities to research. For example, there is no possibility of intellectual property and patents, the potential market is too small, there may be adverse effects on reputation from doing such research (e.g. into cannabis), the proposed remedy may be a one-off cure rather than an ongoing and lucrative treatment.

You say ‘CAM is CAM because it is not science-based. If it were, it would not be “alternative” medicine, it would be medicine.’ What worries me is that this is not a scientific definition. It’s a presupposition which seems designed to keep medicine within the domain of an approved elite.

I think what he means is that in order to make any claims about effectiveness and safety of a given treatment it has to be properly tested. Until it undergoes such testing calling it “medicine” is wrong and irresponsible. At that point it’s an untested hypothesis.

It’s quite possible that there are effective remedies that, for whatever reason, have not attracted attention of research and business outfit who normally undergo such testing. And that’s unfortunate. But it doesn’t mean we can just take any proposed remedy that hasn’t been tested and assume that it’s both safe and effective. Our default assumption should be that it isn’t. That’s how science works.

juga – CAM is not a scientific or well-defined category. I did not invent it. I am opposed to it because it is poorly defined. It exists only to create a double standard. There is only medicine, and it is either based on science and evidence or not (somewhere along that spectrum) no matter what you call it.

In practice CAM is a collection of health claims that are implausible, untested, or already proven not to work. Otherwise they would not need the CAM label.

Regarding what gets researched, your summary is incomplete. There are plenty of funding sources that are not based on the industry or patentability – NIH, MDA, many disease-specific organizations, etc.

Academic researchers have a huge incentive to find new and effective treatments. There’s nothing better for one’s career. Academics are also salaried – the people doing the research do not care if a treatment is lucrative or not. In fact, if anything, cost effectiveness is a positive feature of any new treatment, and brings even more prestige.

I am not saying research funding is perfect, but it is pretty good, and in any case lack of research is no excuse for implausible, silly, and disproved therapies. The “elite” gambit is also pretty lame.

You say ‘CAM is CAM because it is not science-based. If it were, it would not be “alternative” medicine, it would be medicine.’ What worries me is that this is not a scientific definition. It’s a presupposition which seems designed to keep medicine within the domain of an approved elite.

Sort of like when people rule out the ‘supernatural’ by defining ‘nature’ as ‘everything that exists,’ huh?

I could be sympathetic to that argument — but I think the important point to keep in mind here is that no individual therapy, medicine, or modality is being ruled out by presupposition or definition. If good, solid evidence for reiki, homeopathy, or (insert alternative claim here) were to meet the rigorous standards of science then it would have to be accepted into the domain of the approved elite. The label (CAM/notCAM) doesn’t matter if the science-based medicine folks are theoretically both able and willing to admit that hey, they were mistaken about alt-med claim X, it IS real medicine.

I heard someone (at TAM?) give an excellent analogy to what it feels like to be a CAM advocate confronted with a failed test. He said it was like being comfortably able to read music, experienced with the piano, getting up on stage to play a familiar piece — and all the notes are coming out wrong. This … cannot … be. It feels just that wrong.

“He said it was like being comfortably able to read music, experienced with the piano, getting up on stage to play a familiar piece — and all the notes are coming out wrong. This … cannot … be. It feels just that wrong”

Thanks Sastra, I think I’ll keep that one in mind. But I’ll change it from piano to something more familiar, maybe math-related… x = x + 3; 0 = 3?!

If your worldview, education and current source of income were being threatened by those pesky SBM sceptics, wouldn’t you get defensive too? It is basic human psychology that these folks would defend their worldview to the bitter end, no matter what evidence is uncovered by science. They can be expected to lie, cheat and scam in order to maintain their worldview, as have some scientists who are clinging to their belief system, in spite of contradicting evidence. They will be able to justify all of their actions using every psychological trick in the book, including rationalising, projecting and justifying their ends to defend what they “know” is the truth. They simply have too much to lose if they admit, acknowledge or accept that they are wrong and they never will.

It is amazing that this guy, Edzard Ernst, was able to change his point of view and he should be viewed as the exception and not the rule.